“I think that’s the single best piece of advice: constantly think about how you could be doing things better and questioning yourself.”
~Elon Musk
For a printable copy of this tent poster click 2017-01-space x musk
Oklahaven, a non-profit children’s chiropractic center has been dedicated to making sick children well using natural, drug-free chiropractic care for over 55 years. To help fund their efforts the Annual Have A Heart Campaign is held in conjunction with Valentine’s Day each year.
If you’d like to participate, a complete marketing kit is available directly through Oklahaven simplifying the event preparation for your marketing coordinator.
Click here for a pamphlet with more details or visit the Oklahaven “Have A Heart” web-page.
We recommend offering a special promotion to patients who have not been active for 6 months or more.
The links below will take you to a couple of articles describing procedures that can be used to encourage less active patients to come in to see you.
The Reactivation Program has a number of sample letters and a sample postcard and the Reactivation Card is a sample post card that can also be customized for your email newsletter.
Sample Reactivation Postcard – Sample postcard layout and instructions on how to customize your postcard. Information can also be used for email notification.
Reactivation Program An article on the importance of regular reactivation program.
Best Wishes for your New Year!
“The unexamined life is not worth living”
~Socrates
For a printable copy click the link: Unexamined Life-Socrates
Phyllis has been on the Parker Seminar speaker circuit since before starting with PMA. She presents a powerful presentation to motivate and inspire doctors and staff alike.
Coming to you from Las Vegas Nevada, February 23-25, 2017, Phyllis will be joining other colleagues in the chiropractic profession to bring a well rounded presentation of new patient procedures, billing and coding, obtaining referrals, handling objections, creating great patient experiences, and much more specifically designed for your Chiropractic Assistants.
Don’t miss out on this amazing lineup of CA Speakers:
For more information or to register visit parkerseminars.com
or download the flier here: Parker Seminar Flier
Have you received a fax or letter from Center for Medicare/Medicaid Services regarding Comparative Billing Reports? Don’t panic – call me and I will provide an onsite assessment at your practice to ensure your documentation, billing, and coding stay compliant.
Call Lisa: nine two zero 334-4561
Email Lisa: lisa@pmaworks dot com
New Info on Medicare!
Happy Holidays Chiropractic Friends!
First snowfall always seems to bring renewed energies and hope – my wish is you experience this, too.
Are you ready for January 2017? Ready or not, here it comes. Today I want to introduce and give you some of the latest and greatest on what’s happening with the new Medicare reimbursement model also beginning our new year.
To start with, six new acronyms to introduce to you: MACRA, MIPS, CHIP, APM, SGR, CPIA
Here’s a bit of background for you regarding the initiative. In April 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act 2015 (MACRA). This is an act to transition Title XVIII of the Social Security Act to the Medicare sustainable growth rate and strengthen Medicare access. How? By improving physician payments and making other improvements, like the Children’s Health Insurance Program. We could say MACRA is the umbrella to the program.
What is the purpose of the change in reimbursement model? The purposes include simplifying reporting for the convenience and ease of the providers participating; decreasing the current costs of healthcare, allowing patients the best quality of care; and to make patient information sharing safe and easy. The blueprint for pay for performance is the Merit-Based Incentive Payment System, and the goal is to create an acceptable payment system for physicians and the program.
Who are the stakeholders in the broader MACRA program? They include beneficiaries (your patients), businesses, payers, providers, and state partners.
Are you eligible to participate?
Both participating and non-participating providers are eligible to participate if you meet both of the following criteria: 1) Have seen 100 or more unique patients in a year, and 2) Have billed for covered services at $30,000 or more a year. You are exempt from participating in 2017 if 2017 is your first year as a Medicare provider. You are also exempt if you do not meet one of the two criteria above.
How will it work?
CMS has indicated through various webinars that they will notify via written communication if you are or are not eligible to participate. Once you learn of your eligibility, the program will require participating providers to report on three categories for the Merit-Based Incentive Payment System:
Additionally, if you are eligible to participate and choose not to, there will be a negative adjustment of 4% to your Medicare reimbursement. If you are eligible and do choose to participate, you may receive a positive adjustment of 4 to 9% depending on your level of reporting involvement, as well as a minimum 0.5% bonus for exceptional performance if your final reporting score meets or exceeds a certain point value.
You will have two reporting options: You may report for the entire 2017 calendar year, or you may report for the partial year, one quarter, and may begin no later than October 2, 2017.
PM&A will continue to monitor any changes to the above information.
In addition, I will be conducting onsite MACRA readiness assessments at chiropractic offices and am available to visit yours. Please contact me if you are interested in learning more!
Best,
Lisa Barnett, Consultant
Petty, Michel & Associates
Call: nine two zero.334.4561
Email: Lisa@pmaworks dot com
A natural health lending library is a very practical marketing tool – if used.
A lending library is a collection of books, DVD’s, and other information that you can loan your patients. It is part of an ongoing patient education program. The better your patients understand what you do and why you do it, the more likely they will be to stick to a long-term care program and to refer their family and friends for services. Patient education, compared to other marketing activities, is not that expensive. It has a good ROI!
Download a list of suggestions here for your chiropractic or natural health care library. [Ideas for your Lending Library] Please give us your suggestions as well.
This all is logical, right? We all know this.
So…why is it rarely done? Most of the offices that I have seen with lending libraries have them on the bottom shelf in some corner of their office filled with books from a garage sale and old VHS video cassettes.
Everyone knows patient education is important. Like the Spinal Care Class, or new patient education class, everyone knows this is good for the patient and helps the office grow. Right?
Funny story… I attended a small get-together of chiropractors one evening here in Southeast Wisconsin. The presentation was given by the lead doctor of a multiple doctor office. Great doctor, nice practice. He had been in practice for years and looked weathered and ready for retirement. The talk was how to give an effective Spinal Care Class for new patients. The presentation was full of practical content. The only thing… the doctor wasn’t that cheerful about his presentation.
After he finished, and as he left the front of the room looking down at the floor, he muttered, as if passing on a confidential apology to another spy… “But we don’t do the classes anymore.”
So, no need to fool ourselves here. It might be just easier to buy some nice posters and be done with it.
Ah, but there is a trick to making your lending library work… and patient education in general work!
The lending library is primarily for YOU — and each member of your professional team.
We have been looking at it all wrong. The lending library is a reflection of YOU!
If YOU study, and if your support team studies and learns, you all will be so enthusiastic about the information that you will insist that your patients learn this information as well.
Be curious and ask yourself some questions. For example:
Read a book, watch a video, question authority, ask questions — seek the truth. Get excited about learning new things about your profession.
DON’T GET BORED. If you are bored, quit and go home!
Otherwise, be grateful for the opportunities we all have to learn and expand our knowledge and understanding of the services we provide and the world in which we provide them.
Be curious.
Ultimately, you sell yourself before you sell your services. How can you sell a care class or an extended treatment plan if you are not truly excited about them?
Learning new aspects of chiropractic, health care, wellness, sickness, the sickness industry, how your patients are being manipulated and exploited… all this should agitate you one way or another.
For example, I watch Vaxxed – the movie — and then listened to Dr. Andrew Wakefield and Brandy Vaughn (former Merck employee) talk on YouTube about the movie and how they are now being covertly and overtly intimidated to shut up. If this pharmaceutical company is trying to help members of your community get healthier, why are they now attempting to squash dissent and in such a sinister and yet powerful way? I can’t help but wonder: just how powerful are they at manipulating public opinion? How are they influencing my community and my family?
If you look further into the effects of pharmaceuticals, from Vioxx to statins to MMR and vaccines, and explore some of these questions, you can’t help but feel compelled to educate your patients on how to keep their children healthy and free from a toxic environment.
Some of the most successful offices I have seen have spent untold sums on going to seminars (and on coaches!). The verysuccessful can be reckless with book buying and webinar watching and seminar attending.
Continuing education isn’t just for re-licensing seminars. How dull!
If you are not impatiently curious about different aspects of your profession – its science, its philosophy, what it is up against in the market place, you are becoming part of the problem.
Stay curious. Question authority. Study.
Do this:
Assignment #1. You. Order a book – or video- from Barnes and Noble, your local books store, or Amazon. Read most of it on a weekend or weeknight evening rather than watching TV. Present what you learned at the next staff meeting and put the book in your Library.
Assignment #2. Your Team. Have your staff read a few chapters from a book, or watch a video from your lending library and then give a presentation about it at a staff meeting. Everyone learns and the staff member learns twice! Give bonuses for outside study.
Just like we work on our patients, just like we work on our business, we must work ON our roles as professionals and we do this by studying.
Then, no doubt, you and your team will be dragging your patients over to the lending library to check out the latest editions to your collection.
And your patients will know that they came to the right place. They may think you are all a little nerdy, maybe even fanatical about better health, but they will know that you sincerely care about them and their wellbeing, not just in collecting some money for some fast or rushed service.
Assignment #3. Stay curious and learn – and provoke others to do the same.
Sincerely,
Ed
See our attached list of sample books and videos for your Lending Library Ideas for Your Lending Library
Please give us your suggestions for informative books or videos!
*Questions taken from Dan Murphy’s web site.www.danmurphydc.com
“Find your voice, and inspire others to find theirs. Don’t ignore that longing to make a difference”
~Stephen Covey
For a printable copy of this tent poster click the link. [LINK]
“Dreams are free.
Goals have a cost. Time, effort, sacrifice, and sweat.
How will you pay for your goals?”
~Usain Bolt
For a printable copy of this tent poster click here email us.
Petty, Michel and Associates recently attended the Chiropractic Society of Wisconsin’s Annual Fall Summit. The Fall Summit is a great time to get together with others in the profession and share stories of the lives we change on a daily basis.
We always manage to have some team camaraderie also. Saturday as the sessions began to wind down we held our annual Petty, Michel and Associates photo session. Shown below are a few of our favorite shots.
Unlike many of the offices we work with our team is scattered across the country which makes it challenging to physically come together as a team. This year we were able to accomplish having everyone present, and a few extras, for cocktails at the Kalahari’s Diamond Cut and our team dinner at Wally’s House of Embers in the Dells. Lots of chatter, laughter and love shared with all!
Those Blues Bros…. sure know how to treat their team!
Thanks Dave and Ed!
Linda
Team PM&A (Petty, Michel and Associates) recently attended the Chiropractic Society of Wisconsin Fall Summit at the Kalahari in Wisconsin Dells.
Phyllis, Barbara, Lisa, Ed, Dave, Linda and Dana
We are pleased to announce the winner of our succulent dish (door prize): Dr. Chelsea Poland. She is following in her father’s footsteps and she practices in Wausau. Congratulations Dr. Chelsea!
Linda and Dr. Chelsea Poland
The weekend was filled with meeting and greeting chiropractors and their staff. It was fun to see so many of our clients, some of whom I had not yet had a face to a name, meet new docs and their teams, and reconnect with old friends and colleagues to share hugs and spread the love of our profession.
A doctor once told me that no other practice(experience) will ever be the same as my first. I’ve found this to be very true. We hang on to those memories of that first practice. This weekend I was able to reconnect with the first associate Dr. Culp(my first practice) brought into his office, circa 1987. We reminisced of the “old days” and brought each other up to date on our journeys over the past 3 decades.
Dr. Jon Wall and Linda
All in all, it was wonderful to see everyone again and share the weekend with you!
“The world is changed by your example, not by your opinion.”
~Paulo Coehlo
For a printable copy of this tent poster click here. [LINK]
“Champions aren’t made in gyms.
Champions are made from something they have deep inside them – a desire, a dream, a vision.
They have to have the skill, and the will. But the will must be stronger than the skill.”
~Muhammad Ali – 1942-2016
For a printable copy of this tent poster email us.
“I have just three things to teach: Simplicity, patience, compassion. These three are your greatest treasures.” ~Lao Tzu
For a printable copy of this tent poster click here [LINK]
Lisa J. Barnett
Download a PDF of this article
Hello Friends in Chiropractic!
Hope you had an awesome summer and took several opportunities to soak in some UV and Vitamin D.
This month I’d like to both expand on my July Medicare Documentation article and coach you on self-auditing evaluation and management (E/M) coding for reimbursement. Are you consistently under-coding your E/M services? It is not benefiting you to do this because more than likely you’re meeting required elements and not getting the best reimbursement available.
So, what exactly does an auditor, be it Medicare or a Commercial Payer look for in determining reimbursement for your evaluation and management services? It is pretty simple and based on both quality and as it turns out, more importantly, quantity of certain elements. Let’s look in depth how you can self-audit your E/M services*:
First, a coding history and review. In 1992, the current E/M codes were introduced as a result of a ten-year study by CMS(Centers for Medicare and Medicaid Services) and the AMA(American Medical Association). Then in 1995 and 1997, CMS and the AMA developed documentation guidelines (DG) for use of these E/M codes.
Without re-inventing the wheel, let’s lay out how you determine which code to use for your patient evaluations and management of care. To review,
Charting out information from CMS and ACA’s ChiroCode book, here is what we have as quantifiable elements to determine which code to bill for. Keep in mind that Necessity of Care drives our discussion below.
History, Exam, Complexity of decision-making are the three main elements in the evaluation and management note.
Let’s now diagram out for you each code and corresponding description of each element, using both New Patient and Established Patient criteria. What differences do you see? Which descriptions share commonality?
NEW PATIENT
| CODE | HISTORY | EXAM |
COMPLEXITY OF DECISION-MAKING |
| 99201 | Focused/Minor severity | Focused | Straightforward |
| 99202 | Expanded/Low-to-moderate severity | Expanded | Straightforward |
| 99203 | Detailed/Moderate Severity | Detailed | Low |
| 99204 | Comprehensive/Moderate to high severity | Comprehensive | Moderate |
| 99205 | Comprehensive | Comprehensive | High |
ESTABLISHED PATIENT
| CODE | HISTORY | EXAM |
COMPLEXITY OF DECISION-MAKING IN MANAGEMENT OF CARE |
| 99211 | No key component(s) required | No key component(s) required | No Key component |
| 99212 | Expanded/Low-to-moderate severity | Expanded | Straightforward |
| 99213 | Detailed/Moderate severity | Detailed | Low |
| 99214 | Comprehensive/Moderate to high severity | Comprehensive | Moderate |
| 99215 | Comprehensive | Comprehensive | High |
Building on that, here are the quantified components indicating the minimum number of each component’s required presence in the note to code appropriately and at the maximum level:
NEW PATIENT
| HISTORY | EXAM |
COMPLEXITY OF DECISION-MAKING |
||||||
| Code | Chief Complaint | HX of Present Illness | Review of Systems | Past Family/ Social HX | Exam (1997 DG) | Diagnoses | Data to be reviewed; # of Complaints | Risk Factors |
| 99201 | 1 | 1 | N/A | N/A | 1 in affected body area | 1 | 1 | Minimum |
| 99202 | 1 | 1-3 | 1 | N/A | 1-5 | 1 | 1 | Minimum |
| 99203 | 1 | 4+ | 2-9 | 1 | 6-11 | 2 | 2 | Low |
| 99204 | 1 | 4+ | 10+ | 2-3 | 12+ | 3 | 3 | Moderate |
| 99205 | 1 | 4+ | 10+ | 2-3 | All components | 4 | 4 | High |
All 3 elements are required in the new patient note to consider reimbursement: History, Exam, Complexity
ESTABLISHED PATIENT
| HISTORY | EXAM |
COMPLEXITY OF DECISION-MAKING |
||||||
| Code | Chief Complaint | HX of Present Illness | Review of Systems | Past Family/ Social HX | Exam (1997 DG) | Diagnoses | Data to be reviewed; # of Complaints | Risk Factors |
| 99201 | 1 | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| 99202 | 1 | 1-3 | N/A | N/A | 1-5 | 1 | 1 | Minimum |
| 99203 | 1 | 1-3 | 1 | 1 | 6-11 | 2 | 2 | Low |
| 99204 | 1 | 4+ | 2-9 | 2+ | 12+ | 3 | 3 | Moderate |
| 99205 | 1 | 4+ | 10+ | 2+ | All components | 4 | 4 | High |
Two (2) out of the 3 elements are required in the established patient note to consider reimbursement: History, Exam, Complexity
As you may deduce from the above established patient table, 99211’s are rarely used in chiropractic offices. Can you see why?
Additionally, give your current score an extra two points for management of care, i.e., reviewing old records and summarizing in the note stability/worsening of condition, or, two points for obtaining history from someone other than the patient. Add one point for diagnostics performed and reviewed, (i.e., x rays).
Finally, make sure to attached your -25 modifier on all E/M codes if you are giving a CMT on the same DOS.
Have a specific patient in mind and you’d like to find out if you coded and billed at the most appropriate and highest level? Contact me on how you can qualify for a complimentary audit! Call 920.334.4561 or email lisa@pmaworks.com
Sincerely in Chiropractic,
Lisa Barnett,
PM&A Coach and Consultant
Where Managing by Numbers and Progress Says It All.
My purpose is to be the Best Chiropractic Advocate in the World
*EHR systems may already have built-in features to automate the components for you via their macros/templates.References:
List of Components:
History of Present Illness – Elements:
Location (example: left leg); Quality (example: aching, burning, radiating pain); Severity (example: 90 on a scale of 1 to 100); Duration (example: started 3 days ago); Timing (example: constant or comes and goes); Context (example: lifted large object at work); Modifying factors (example: better when ice/heat is applied); and Associated signs and symptoms (example: numbness in toes)
Review of Systems:
Constitutional Symptoms (for example, fever, weight loss); Eyes; Ears, Nose, Mouth, Throat; Cardiovascular; Respiratory; Gastrointestinal; Genitourinary; Musculoskeletal; Integumentary (skin and/or breast); Neurological; Psychiatric; Endocrine; Hematologic/Lymphatic; and Allergic/Immunologic
Past Family/Social History:
Past history includes experiences with illnesses, surgeries, injuries, and treatments/medications. Family history includes a review of medical events, diseases, and conditions that may place the patient at risk. Social history includes an age-appropriate review of past and current lifestyle activities.
To download the article in it’s entirety click the here [LINK]
“Train people well enough so they can leave… treat them well enough so they don’t want to.”
-Sir Richard Branson business magnate, investor and philanthropist.
For a printable copy of this tent poster click: [LINK]
We know all too well how keeping abreast of all the changes in the insurance world can sometimes be overwhelming for your practice so we wanted to simply help you out by sharing some recent information regarding ICD-10 codes.
ChiroCode Institute recently published the changes to ICD-10 Codes that are going into effect October 1st. While there are thousands of code changes, we have listed below the codes most relevant to chiropractors. To download a printable copy of this list click here [ICD-10-Changes-Oct-2016]
ICD-10 Reference:
Gwilliam, Evan M, DC MBA BS CPC CCPC NCICS CPC-I CCCPC MCS-P CPMA, ChiroCode Institute
If you have any questions regarding these changes Petty, Michel and Associates would be glad to help guide you in the right direction. Please email to services@pmaworks.com or call us at 414-332-4511. We are here to help!
“People are like bicycles…they can keep their balance only as long as they keep moving.”
~Albert Einstein
For a printable copy of this tent poster visit: Einstein Bicycle balance
“The way we’re running the company, the product design, the advertising– it all comes down to this: let’s make it simple, really simple.” Steve Jobs (Walter Isaacson) 1.
If you could simplify your business even more than it is, you would make more money and have less stress.
There is a direct relationship between simplicity and productivity, and an inverse relationship between complexity and productivity.
The most successful businesses have capitalized on this fact. This was one of Apple computer’s unique selling propositions – to focus on the simple and eliminate what wasn’t essential.
From its inception, the Apple Macintosh computer was designed with simplicity in mind. Other companies have focused on simplicity: McDonalds order via drive-through, Ikea with its simple design, and Amazon with one-click ordering.
Siegal-Gale is an international marketing firm that has studied simplicity in business and has been able to profile and rank businesses according to their simplicity. They call this the Global Brand Simplicity Index and have found that those companies that rank the highest, also outperform companies that rank as more complex. Their report states (2):
You want to simplify the experience your chiropractic (or other) patient has in your office. From the first phone call, first appointment, examination, report of findings, patient finances, and scheduling, discover ways to simplify your procedures.
Your intake forms may be redundant or complicated, there may be too many rote statements or “scripts” for your staff to say to patients, or there can be extra pathways that your patients have to travel, like so many rabbit trails, where they can get confused and the flow slows down. Staff, or doctors, may have too many decisions to make at each visit.
For example – what extra therapy should the patient receive? Not knowing, I have heard support staff simply ask the patient what therapy they wanted today, as if they were ordering a latte. And as we know, there are definitely too many codes and documentation rules to follow for the doctor. Going total cash is one solution, but intelligent software, dictation, and scribes are other solutions.
Many, if not a majority of the more profitable offices that I have worked with over the years practiced what could be called “straight” chiropractic. The straight practice (no additional modalities) works well, when it does, because its procedures and flow are simple. It is usually more profitable because extra overhead hides in the complicated.
Steve Jobs again: “People think focus means saying yes to the thing you’ve got to focus on. But that’s not what it means at all. It means saying no to the hundred other good ideas that there are. You have to pick carefully. I’m actually as proud of the things we haven’t done as the things I have done. Innovation is saying no to 1,000 things.”— Steve Jobs, WWDC 199(3)
I am not advocating no supplements, no exercise physiology, no electrical therapy. But to be honest, how much of this gets used in your office? I know offices — right now, and have known hundreds more, that have equipment lying around unused or bottles of vitamins collecting dust on overlooked shelves.
You have to embrace first only those unique outcomes that you can deliver. Work backwards and add only the most critical steps. “Begin with the end in mind”, as Stephen Covey observed in high producers.
For a chiropractor, this means adjust. (For other professions: what is your core function?) One of the first doctors I worked with when I moved to Wisconsin in 1988 worked closely with Clarence Gonstead. His license plate read: I ADJUST. He had a full practice, chuckled a lot, and seemed to make a nice living.
Start with this first, and then add additional services carefully – if you want.
Secondly, educate. Educate your patients, your team, and your community. But your education has to be simple. Your message has to be concise. One doctor we have worked with over the years has a waiting list practice, with nonstop patient, and even some MD, referrals. He doesn’t do a 4-day report of findings and he doesn’t do a 2-day report of findings on new or reactivated patients.
He just very intently adjusts and talks about the adjustment and what he is adjusting. From there, he then also gets into other health topics such as toxins (vaccinations), nutrition and weight, and exercise.
This is a good model: start with your core service and move out from there. For chiropractic education, you can use simple metaphors like “pinched nerve,” “garden hose,” “rusty gate hinge”, and how the body fighting toxins creates heat (inflammation), etc.
And keep educating your patients with care classes, lending library, table talk, movie nights, special speakers, case histories, and testimonials.
And do this first and continually with your support team. This is not done enough!
One method to discover what to simplify is to regularly practice your procedures. For example, do a rehearsal of what happens when a new patient comes into your office on their first day, 2nd day, 3rd day, etc. You will flush out confusions, redundancies, and extra motions that complicate the patient experience.
Outside of your office, the same applies. Educate your community on what you do. What is your simple selling proposition that people want?
For example, someone asks you “what do you do?”: “Well…
we help to improve your health, we relieve your pain,
and we increase your game – naturally!
No drugs, no surgery, and we guarantee you have fun in the bargain.”
How’s that? A simple and a desirable unique selling proposition (USP). (You can use this in all your marketing communications – no charge!)
Lastly, there is fun. You can and should have fun doing this. And so should your patients and support crew.
Patients will mostly remember how they feel after leaving your office. Was it a pleasant, enjoyable experience? Was it fun?
Practice life can often bring about a kind of serious hue over the office. Administrative errors, missed appointments, a dissatisfied patient, a staff member out for the day, too many bills – all of this can create an extra layer of anxiety or seriousness in the office.
Fight this by being grateful for all the wonderful outcomes of your patients. Work on having a “the gratitude attitude.”
And as you simplify your processes, you will find that everyone’s attention becomes freer to enjoy helping each other — to help the patients.
Simple is more fun and profitable.
So here is a question for you: Which comes first, the fun or the smile?
Well, you can kick things off right now… right now with a smile. Actually, smiling is simpler and requires less muscles than frowning.
Frowning is complex, so start right now by smiling.
Try it.
See? Already your business and life is simpler and better – and funner.
-Ed
(To help you keep things simple, you can order two magnets of the above image for your office, courtesy of PM&A while quantities last. Click here to order. We will mail them to you at no charge.)
For a printable copy of this article click [The Power of Simplicity]